| NPI | 1417987009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS LIC-4-08-2400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 04628) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2010-08-09 |